Ben Fawcett

Broadcast:

Wednesday 19 March 2008 5:55PM

The Great Stink

Supporting Information

Exactly 150 years ago, a hot summer and the effluent from growing numbers of water closets reduced the river Thames in London to what was publicly termed a 'Great Stink'. MPs, sitting in the House of Commons next to the river, fearful of catching cholera from the fumes, rapidly introduced legislation for sanitary reform and agreed funding for construction of sewers to clean up the river. Only seven years later, the main sewer, designed and built by Joseph Bazalgette, was opened with a banquet attended by the Prince of Wales, the Archbishop of Canterbury, and 500 other distinguished guests, who dined on salmon as the city's excreta gushed forth beneath them.

Today, a sanitary crisis exists throughout the developing world, equivalent to that in Victorian London, but on a massively larger scale. At least a billion people - one sixth of the world's population - live in slums and shanty-towns as unhealthy as those in Britain's nineteenth-century towns and cities, with similar health and social problems. This number is growing rapidly. A total of more than 2.6 billion people, in cities, towns and the countryside, lack any decent place to relieve themselves. They use urban alleyways, waste-tips, river banks, and railway-lines, and rural fields and forests. In Mbare, an inner-city slum next to Harare's main market-place in Zimbabwe, 1,300 men, women and children share one communal toilet with no electric light; naturally this is usually blocked. Nevertheless, the city authorities consider that, because of this one toilet, Mbare is adequately served!

The results of this crisis are numerous and disastrous, particularly for small children and women. At least 1.5 million children under-5 die every year from diarrhoeal disease. There are around 133 million cases of infestation with intestinal worms. A typical roundworm load absorbs around a third of the food a child consumes - this is a leading cause of malnutrition. The transmission of trachoma, the second most common cause of blindness worldwide, and of bilharzia, which infects over 200 million, mostly children, is dramatically reduced by improved sanitation. Most primary schools in Africa and Asia are built without toilets; girls drop out of school, especially on reaching puberty, when they cannot protect their modesty by use of a private toilet. In India, more than 200 million women are expected to 'hold themselves in' all day; only after dark can they seek secluded places to squat, risking harassment and sexual attack.

The Victorian sanitary revolution, with heroes such as Edwin Chadwick, the father of British public health, engineer Bazalgette and Dr John Snow - who famously removed the handle from the Broad Street pump in Soho to stop the spread of cholera - has many lessons for the contemporary world. Improvements in public health will only arise from the combined efforts of local householders, their leaders, local entrepreneurs, municipal departments, national governments and international donors. A range of technologies exists, from composting toilets, the 'pour-flush', the VIP (or ventilated improved pit) toilet, to simplified sewers, but the expensive, conventional waterborne sewer, with its demand for 15,000 litres of water per person every year, is not the solution for most poor, water-short developing countries. Despite the appalling health impacts of inadequate sanitation, these do little to motivate poor families to improve their facilities. There is widespread demand for better toilets, but this derives from issues of convenience, dignity and status more than health. A market that caters to these concerns must be developed. Local government budgets must be adjusted to reflect the funding that is necessary, supported by aid from wealthy nations. In Madagascar only a miserable half a US cent per person is allocated for sanitation each year. The local government coordinator for sanitation naturally laments: "What can I possibly do with that?" But funding is far from the only requirement.

A new sanitary revolution is vitally needed now, with champions of the stature, vision, commitment and energy of Chadwick, Bazalgette and Snow, to stir the interest of the present-day, global equivalents of the nineteenth century Prince of Wales and Archbishop of Canterbury. We need to overcome our natural distaste about this subject and bring this crisis out of the 'closet', into the open. Shit happens - we all know that - together we have the means to manage it safely for everybody.